title: Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial.
abstract: OBJECTIVE
  Prevention strategies for heart failure are needed.
  
  
  OBJECTIVE
  To determine the efficacy of a screening program using brain-type natriuretic peptide (BNP) and collaborative care in an at-risk population in reducing newly diagnosed heart failure and prevalence of significant left ventricular (LV) systolic and/or diastolic dysfunction.
  
  
  METHODS
  The St Vincent's Screening to Prevent Heart Failure Study, a parallel-group randomized trial involving 1374 participants with cardiovascular risk factors (mean age, 64.8 [SD, 10.2] years) recruited from 39 primary care practices in Ireland between January 2005 and December 2009 and followed up until December 2011 (mean follow-up, 4.2 [SD, 1.2] years).
  
  
  METHODS
  Patients were randomly assigned to receive usual primary care (control condition; n=677) or screening with BNP testing (n=697). Intervention-group participants with BNP levels of 50 pg/mL or higher underwent echocardiography and collaborative care between their primary care physician and specialist cardiovascular service.
  
  
  METHODS
  The primary end point was prevalence of asymptomatic LV dysfunction with or without newly diagnosed heart failure. Secondary end points included emergency hospitalization for arrhythmia, transient ischemic attack, stroke, myocardial infarction, peripheral or pulmonary thrombosis/embolus, or heart failure.
  
  
  RESULTS
  A total of 263 patients (41.6%) in the intervention group had at least 1 BNP reading of 50 pg/mL or higher. The intervention group underwent more cardiovascular investigations (control, 496 per 1000 patient-years vs intervention, 850 per 1000 patient-years; incidence rate ratio, 1.71; 95% CI, 1.61-1.83; P<.001) and received more renin-angiotensin-aldosterone system-based therapy at follow-up (control, 49.6%; intervention, 56.5%; P=.01). The primary end point of LV dysfunction with or without heart failure was met in 59 (8.7%) of 677 in the control group and 37 (5.3%) of 697 in the intervention group (odds ratio [OR], 0.55; 95% CI, 0.37-0.82; P = .003). Asymptomatic LV dysfunction was found in 45 (6.6%) of 677 control-group patients and 30 (4.3%) of 697 intervention-group patients (OR, 0.57; 95% CI, 0.37-0.88; P = .01). Heart failure occurred in 14 (2.1%) of 677 control-group patients and 7 (1.0%) of 697 intervention-group patients (OR, 0.48; 95% CI, 0.20-1.20; P = .12). The incidence rates of emergency hospitalization for major cardiovascular events were 40.4 per 1000 patient-years in the control group vs 22.3 per 1000 patient-years in the intervention group (incidence rate ratio, 0.60; 95% CI, 0.45-0.81; P = .002).
  
  
  CONCLUSIONS
  Among patients at risk of heart failure, BNP-based screening and collaborative care reduced the combined rates of LV systolic dysfunction, diastolic dysfunction, and heart failure.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00921960.
authors.affiliation: Chronic Cardiovascular Disease Management Unit, St Vincent's Healthcare Group/St Michael's Hospital, Dublin, Ireland.
authors.forename: Mark
authors.initials: M
authors.lastname: Ledwidge
authors.forename: Joseph
authors.initials: J
authors.lastname: Gallagher
authors.forename: Carmel
authors.initials: C
authors.lastname: Conlon
authors.forename: Elaine
authors.initials: E
authors.lastname: Tallon
authors.forename: Eoin
authors.initials: E
authors.lastname: O'Connell
authors.forename: Ian
authors.initials: I
authors.lastname: Dawkins
authors.forename: Chris
authors.initials: C
authors.lastname: Watson
authors.forename: Rory
authors.initials: R
authors.lastname: O'Hanlon
authors.forename: Margaret
authors.initials: M
authors.lastname: Bermingham
authors.forename: Anil
authors.initials: A
authors.lastname: Patle
authors.forename: Mallikarjuna R
authors.initials: MR
authors.lastname: Badabhagni
authors.forename: Gillian
authors.initials: G
authors.lastname: Murtagh
authors.forename: Victor
authors.initials: V
authors.lastname: Voon
authors.forename: Leslie
authors.initials: L
authors.lastname: Tilson
authors.forename: Michael
authors.initials: M
authors.lastname: Barry
authors.forename: Laura
authors.initials: L
authors.lastname: McDonald
authors.forename: Brian
authors.initials: B
authors.lastname: Maurer
authors.forename: Kenneth
authors.initials: K
authors.lastname: McDonald
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002309:Cardiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003971:Diastole; D004452:Echocardiography; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000517:prevention & control*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010348:Patient Care Team; D015995:Prevalence; D011320:Primary Health Care; D011446:Prospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology*
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain